Individual provider Active NPI

Tiffany Nicole Stewart, APRN

  • Family Nurse Practitioner
  • Petersburg, VA
National Provider Identifier
1386166411
Registry record updated Jan 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024183941 Issued in VA
Practice address
25 S Union St
Petersburg, VA 23803-4221
Phone
(479) 586-2335
Fax
(804) 957-5850
NPI assigned
Jul 11, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X A005246 AR
Family Nurse Practitioner 363LF0000X 0024183941 VA Primary

Addresses

Primary practice location

25 S Union St
Petersburg, VA 23803-4221

Mailing address

25 S Union St. Petersburg, VA 23803
Fayetteville, AR 23139-5002
Phone (479) 586-2335

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220624000141 VA Practitioner - Nurse Practitioner 8123392156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

165 Legrande Ave
Charlotte Court House, VA 23923-3747
Phone (434) 542-5560

2256 Irish Rd
Esmont, VA 22937-1945
Phone (434) 286-3602

25 S Union St
Petersburg, VA 23803-4221
Phone (804) 957-9601

541 S Sycamore St
Petersburg, VA 23803-5039
Phone (804) 835-6100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A005246ARMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Virginia Health Services Inc CurrentSince Sep 12, 2022 Accepting new patients
Central Virginia Health Services Inc CurrentSince Sep 12, 2022 Accepting new patients
Central Virginia Health Services Inc Past Accepting new patients

Locations

25892 N James Madison Hwy
New Canton, VA 23123
Phone (434) 581-3271

25 S Union St
Petersburg, VA 23803
Phone (804) 957-9601

Interoperability endpoints

  • Direct secure messaging: tiffany.stewart.1@14940.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1386166411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 S UNION ST. PETERSBURG, VA 23803",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "231395002",
            "telephone_number": "479-586-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 S UNION ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034221",
            "telephone_number": "479-586-2335",
            "fax_number": "804-957-5850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "TIFFANY",
        "middle_name": "NICOLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-11",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AR",
            "license": "A005246",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024183941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

Verify at the official NPI Registry.